联用维拉帕米、利多卡因降低气管拔管时心血管副反应

Effect of verapamil－lidocaine combination on cardiovascular response to tracheal extubation

目的：比较静脉联合应用维拉帕米和利多卡因与两药单独应用降低气管拔管引起的心血管反应的有效性。方法：选80例ASA Ⅰ～Ⅱ级择期上腹部手术患者，随机分成4组，每组20例。A组：生理盐水组；B组：利多卡因组(利多卡因1 mg/kg+生理盐水)；C组：维拉帕米组(维拉帕米0.1 mg/kg+生理盐水)；D组：维拉帕米复合利多卡因组(维拉帕米0.1 mg/kg+利多卡因1 mg/kg+生理盐水)。均于气管拔管前2 min给药，拔管时和拔管后均监测心率(HR)、收缩压(SBP)、舒张压(DBP)。结果：A组HR、SBP、DBP于气管拔管后显著增加，B、C、D组和A组相比均有不同程度的降低(Ｐ＜0.05～Ｐ＜0.01)，其中D组效果最好。结论：维拉帕米、利多卡因拔管前2 min给药均能降低气管拔管引起的心血管副反应，两药联合应用优于单独使用。

Objective:To compa re the efficacy of combination of intravenous(Ⅳ) verapamil and Ⅳ lidocaine with that of each drug alone in suppressing the cardiovascular changes during trach eal extubation.Methods:Eighty adult patients(ASA physical status Ⅰ～Ⅱ) who were t o under go elective upper abdominal operation were randomly assigned to one of f our groups(n=20 each):Group A=saline plus saline(control),Group B=lidocaine 1 mg/kg Ⅳ plus saline,Group C=verapamil 0.1 mg/kg Ⅳ plus saline,Group D=verapamil 0.1 mg/kg Ⅳ plus lidocaine 1 mg/kg Ⅳ.These medications were given 2 min b efore tracheal extubation.Changes in heart rate(HR),arterial systolic and diasto lic blood pressure(SBP、DBP) were measured during and after tracheal extubation.Results:In the control group,the HR\,SBP and DBP increased significantly during tracheal extubation.Verapamil\,lidocaine and their combination atten uated the increases in these variables(Ｐ＜0.05～Ｐ＜0.01).The benificia l effect was the greatest with the combination of verapamil and lidocaine.Conclusions:Verapamil 0.1 mg/kg and lidocaine 1 mg/kg given Ⅳ conco mitantly 2 min before tracheal extubution is more effective prophylaxis than ver apamil or lidocaine alone for attenuation the cardiovascular changes associated with tracheal extubation.